PUBLIC SECTOR FINANCING AND EXPENDITURE ON MEDICATIONS. PANAMA 2007-2011.

Beatriz Gómez1, Carlos Gordón1, Víctor Herrera Ballesteros1, Reina Roa1, Luis Ortega- Paz1, Manuel Pereira1

1 Instituto Conmemorativo Gorgas de Estudios de la Salud Fact Sheet: Republic of Panama

Background The economic and financial challenges that burden the global economy hinder the goal of universal access to essential medications in numerous countries. From an economic and sanitary standpoint, there is a need to evaluate the effectiveness of financing mechanisms and

Economic, Social, and Health Indicators of the Republic of Panama. 2010.

Age structure (%)

0- 14 years: 29.2 15- 64 years: 63.4 64 years and over: 7.4

Sex structure 101.1 men/ 100 women

Life expectancy at birth

Both sexes: 75.9 years

Estimated Proportional Mortality by Major Causes of Death in Panama According to Gender, 2001-2009.

Men Women

the public sector’s expense on medications. Some of the main issues faced by developing countries in this regard include the lack of integrated information systems, inadequate standardization of coding methodologies, and the use of outdated technologies. This problem is aggravated by insufficient training of the personnel in charge of keeping the records and

Population: 3,405,813 inhab.

Area: 75,510 km2

PIB: 20,862.9 millions US dollars

GDP per capita: 5,953 US dollars

Health expenditure per capita 2011: 616 US dollars

Public expenditure in medication as % GDP 2007- 2011: 0.67%

Annual % of growth: 7.5%

Population in poverty: 32%

Indigenous population (%): 12.3%

Afro population (%): 9.2%

Male: 73.3 years Women: 78.6

Mortality

Crude rate: 4.5/ 1,000 inhabts. Infant mortality rate: 12.2/ 1,000 inhabts

Source: INEC/ MINSA

gene Source: Life Events: Mortality, 2001 - 2009. INEC

gene

Global Medication Expense in Public Health Institutions

ultimately results in ineffective planning and decision making by the sanitary authorities in those countries.

Organization of Health Facilities. %

Attention and Complexity levels.

200,000,000.00

(MINSA - CSS) and as % GDP. Panama. 2007-2011.

0.76 0.8

Objectives To develop a financing and expenditure on medications information system for Panama’s public health institutions: the Ministry of Health (MINSA) and the Social Security (CSS), during the period 2007-2011.

Materials and Methods A database incorporating information of MINSA and

Sources of financing National Budget Regional Budget Extraordinary Credit Self-financing Donations

III LEVEL National Hosp.

Specialized Hosp

II LEVEL Regional Hospitals and

Clinics

I LEVEL Primary Health Care facilities

Society

Medications

The distribution and access is related to the health attention and complexity levels

180,000,000.00

160,000,000.00

140,000,000.00

120,000,000.00

100,000,000.00

80,000,000.00

60,000,000.00

40,000,000.00

20,000,000.00

CSS

MINSA TOTAL %GDP

0.59

101

76

25

0.62

105

87

71

34

0.71

138

94

51

0.71 176

150

104

72

55

0.7

0.6

0.5

0.4

0.3

0.2

0.1

CSS institutions by level of care was created. Economic and ATC (Anatomical, Therapeutic, Chemical Classification System) variables of the medications were registered. Data from the Vital Facts Registry 2001-

Health policy, regulation and vigilance

Provider of health services

.00 0 2007 2008 2009 2010 2011

Years

672,951,707.52 US dollars

2010, National Census 2010, Household Income and Expense 2007 survey, statistics from the Ministry of Health, and reports on the medication’s price increases published by the Consumer Protection and Competition Authority were also included in the analysis. A self-organizing map (SOM) was applied to the CSS and MINSA medication expenditure databases. Geographic Information Technologies were used and results were presented in a webmap format.

Global Medication Expense in Public Health Institutions (MINSA - CSS) by Pharmacologic Group. Panama. 2007-2011.

ANTINEOPLASTIC AGENT

GENERAL SYSTEMIC ANTIBIOTICS

BLOOD AND BLOOD DERIVATIVES

CARDIOVASCULAR SYSTEM

ALIMENTARY TRACT AND METABOLISM

MENTAL HEALTH

HIV

CENTRAL NERVOUS SYSTEM

RESPIRATORY SYSTEM

MUSCULOSKELETAL SYSTEM

DERMATOLOGIC PRODUCTS

SYSTEMIC HORMONES

GENITOURINARY SYSTEM

ORGANS OF SENSES

VARIOUS

Vaccine Expenditure by Health Region and by the 10 Vaccines of Greatest Expense. Panama. 2007-2011.

10,000,000.00 9,000,000.00 Results

An increase in Panama’s public sector medication expenditure was observed, from US$ 101.6 million in 2007 to US$ 176.8 million in 2011. The groups of medications representing the greatest expense (millions of US$) in descending order include: antineoplastic and

ANTIPARASITICS

SERUMS AND IMMUNOGLOBULINS IMMUNOSUPRESSORS

TOBACCO CESSATION

TOTAL PARENTERAL NUTRITION

ANTISEPTICS

0

50000000

Amount (US dollars)

100000000

MINSA CSS

150000000

8,000,000.00

7,000,000.00

6,000,000.00

5,000,000.00

4,000,000.00

3,000,000.00

2,000,000.00

1,000,000.00

0.00

63,250,060.73 US dollars

PNEUMOCOCCAL ADULT INF.TRIVALENTE INF.H1N1 PENTAVALENT ROTAVIRUS

Vaccines

HEPATITIS A DPAT ADACEL. INFLUENZA PED.Y ADULT

PAPILOMA V V-PREV

immunologic agents US$ 134.3, systemic antiinfectives US$ 85.9, blood and blood derivatives US$ 71.3, and

Medication Expenditure in National Hospitals of CSS and MINSA. Panama. 2007- 2011

Children´s Hospital

Per Capita Medication Expenditure of Health Institutions (MINSA-CSS) by Health Region. Panama. 2007-2011.

cardiovascular drugs US$ 64.6 million. The six Panamá. 2007- 2011

3,044,400.41 8,923,936.01 MINSA

National Institute for Mental Health specialized national hospitals had a total medication

expense of US$ 249.5 millions, which was higher than the rest of the country’s public health network. Spending on vaccines increased, a fact which can be explained by the inclusion of new vaccines in the vaccination schemes. SOM analysis revealed that the CSS segment corresponding to the Metropolitan Hospital was composed of specialized and costly medication purchases, in contrast to MINSA, CSS

32,735,575.69

18,117,772.20

9,342,421

National Oncologic Institute

Santo Tomas Hospital

Children´s Hospital CSS

CSS Metropolitan Hospital

177,324,526.01 120

100

80

60

40

Per capita (annual average) 38 US dollars

104

5

0 52

27 36 regional hospitals, and CSS polyclinics who appeared to be more focused on chronic and infectious diseases. The per capita medication expense was greater in areas with more urban development. This suggests that national

249,448,630 US dollars 20

0

18 7 13 16

Panamá Oeste Panamá Este San Miguelito Ngäbe Buglé

19 20 22 24

Guna Yala Colón Darién Bocas del Toro

Health region

24

Coclé Veraguas Chiriquí

Herrera Metro Los Santos

hospitals, which are located in the metropolitan area, are concentrating specialized healthcare versus regional hospitals.

Conclusions The reasons that may explain the increase in the public sector’s medication expenditure include: an increase in life expectancy, the epidemiologic profile of the country, the expanded health coverage of the CSS, the public sector’s organizational model for the provision of health services, and asymmetries in the national market. The State should develop national medication accounts, which would allow a better understanding of how the expenditure is structured; evaluate alternatives for optimizing medication expense; and improve the social and geographic access to medications.

Principal Medication Expense Segments in CSS. 2007- 2011. Self Organizing Map Analysis

Panamá. 2007- 2011

Segment 1 Segment 2 Segment 3

Segment 1: cardiovascular system (21%), central nervous system (14%), and mental health (14%). Segment 2: antineoplastics (28%), blood and blood derivatives (12%), alimentary tract and metabolism (9.5%), cardiovascular, and nervous system (8 and 9% respectively) Segment 3: Cardiovascular system (15%), general systemic antibiotics (14%), and nervous system (12%).

Principal Medication Expense Segments in MINSA. 2007-2011. Self Organizing Map Analysis

Panamá. 2007- 2011

Segment 1 Segment 2 Segment 3 Segment 4

Segment 1: respiratory system (14%), cardiovascular system (12%), blood and blood derivatives (10%), and HIV (10%). Segment 2: blood and blood derivatives (18%), cardiovascular system (13%), and respiratory system (15%) Segment 3: general systemic antibiotics (100%) Segment 4: alimentary tract and metabolism (100%)

Department of Research and Assessment in Health

Technology

ICGES. Panamá, Ave. Justo Arosemena y calle 35. Tel.: (507) 527 - 4811 Fax: (507) 527 - 4889 Apartado Postal: Nº 0816 - 02593. Panamá, República de Panamá.

Email: beatrizg@gorgas.gob.pa; cgordon@gorgas.gob.pa http://www.gorgas.gob.pa/SIGMED/Home1.htm